The present invention relates to gastric reduction and, more particularly, to a procedure and device for achieving a reduction in the size of the stomach, particularly in order to treat obesity in humans.
Gastric reduction surgery is conventionally performed to restrict food intake of a patient by decreasing the size of the stomach to a reservoir having a volume of on the order of about 15 mL. This operation thus limits the receptive capacity of the stomach and promotes weight loss in patients with severe obesity. The most commonly performed gastric reduction operation is vertical stapled gastroplasty. This procedure involves incision of the anterior abdominal wall and creation of a 10-15 ml pouch from the proximal stomach by use of 3-4 staples. This procedure may have numerous complications including rupture of the staple line, infection of the surgical incision, post operative hernias and the like. Moreover, due to the large amount of fat tissue in the anterior abdominal wall in the typical patient on whom this procedure is performed, poor healing of the operative wound may result. Furthermore prolonged post-operative bed rest after such extensive surgery predisposes obese patients to the development of deep vein thrombosis and possible pulmonary emboli, some with a potentially lethal outcome.
We have developed a novel approach to achieving a reduction in the size of the stomach utilizing a flexible endoscope and, in a preferred embodiment, without any surgical incisions. More specifically, we have developed a technique for reducing the stomach cavity endoscopically, from within the stomach or, in the alternative, from within the peritoneal cavity via a wall of the digestive tract. Gastric reduction endoscopy utilizing either of these techniques will have an excellent cosmetic result as there are no incisions in the abdominal wall and thus no potential for post-surgical scars or hernias. Moreover, for the severely obese patient, the endoscopic approach eliminates the risks of an incision through the large amount of fat tissue in the anterior abdominal wall.
Our new approach for reducing gastric capacity uses a flexible endoscope and a specially adapted ligating loop. More specifically, the endoscopic procedure of the invention proposes to reduce the capacity of the stomach by securing a loop at spaced locations about the interior wall of the stomach and then constricting the loop to draw together the gastric wall, to thereby effectively reduce the food receiving cavity defined at the base of the esophagus. Accordingly to the presently preferred embodiment, the ligating loop is a slip knotted loop. As an alternative to an internal application of the loop, the loop can be applied to the exterior surface of the stomach. According to this alternative, we access the peritoneal cavity via an incision through the wall of the digestive tract, using the techniques described in our co-pending application No. 09/815,336, filed Mar. 23, 2001, the entire disclosure of which is incorporated herein by this reference, and then secure the loop to the exterior surface of the stomach. Constricting the thus applied loop will also achieve a reduction in the capacity of the stomach. Because the gastric reduction technique described hereinbelow proposes to collapse a portion of the stomach using a suitably disposed slip knotted loop, it will be appreciated that the gastric reduction technique may, in extraordinary circumstances, be reversed by severing the ligating or constricting loop, so that the stomach can return to its original capacity.